Provider Demographics
NPI:1841291937
Name:MAVITY, MARK EDWARD (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:MAVITY
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9105 BRAMBLE PL
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-4015
Mailing Address - Country:US
Mailing Address - Phone:703-764-1736
Mailing Address - Fax:
Practice Address - Street 1:11 MEDICAL GROUP
Practice Address - Street 2:238 BROOKLEY AVENUE
Practice Address - City:BOLLING AFB
Practice Address - State:DC
Practice Address - Zip Code:20332-0001
Practice Address - Country:US
Practice Address - Phone:202-404-5866
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066025L2083A0100X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Not Answered2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine